Patient-centered medical home could reduce costs and improve care

When people do not have healthcare insurance or money to pay to see a doctor, they do not get basic medical care. Then often the problem gets worse and the sick person heads to the local emergency room (ER) for care knowing that the hospital cannot refuse to treat them.

According to Blue Cross & Blue Shield, the national average ER visit costs $383, while the national average doctor’s office visit is $60. Unnecessary ER visits can delay care for those with true emergencies and cost billions of dollars.

Healthcare dollars would be far better spent if people got appropriate primary care early on rather than waiting until the disease progresses.

One concept that is gaining steam in the U.S. is called a “patient- centered medical home.” This is a model touted by medical groups such as the Mississippi Academy of Family Physicians (MAFP), and is a component of the healthcare reform proposals of President-elect Barack Obama.

“One of the most exciting things in his plan is the emphasis on preventative care and primary care in particular,” said Dr. Jason Dees, a family practice physician with the New Albany Medical Group who is chairman of the MAFP Patient-Centered Medical Home Task Force. “We have good evidence from around the world that systems which spend more on primary care and building relationships between patients and physicians have better healthcare. I think the emphasis Obama-Biden places on that may be one of the best aspects of their program. They recognize if we can prevent disease on the front end, we won’t spend as much to treat it on the back end.”

Dees said there could be huge savings from paying for preventative services that allow diseases to be caught and treated much earlier.

“Yes, we might spend more now,” Dees said. “But, over the long term, we would save money. We know patient-centered medical homes, homes where everyone has access to a primary care physician, save money. They lower healthcare costs and improve the quality of care.”

One huge benefit is coordination of care. Now sometimes a patient will go to several doctors and get a number of different prescriptions. One doctor may not know what has been prescribed by another, which can lead to drug interaction complications damaging to health.

Dees said with the patient-centered medical home, there is a big emphasis on disease management and using disease registries. Patients have interaction with a physician-led team that includes nurses, case management specialists and social workers.

“We improve quality and lower costs over time because of that coordination and integration of care,” Dee said.

The concept could be particularly important in Mississippi, which often ranks last or next to last in health indicators. Part of that is a result of the state’s low per capita income.

“One of the most interesting things about the patient-centered medical home that is especially important in Mississippi is that you start to see disparities in healthcare disappear,” Dees said. “Whether you are rich or poor, black or white, differences based on racial, ethnic and economic groups vanish when you have a relationship with a primary care physician-led medical home. Imagine if every Mississippian had access to that kind of care where disparities in care would disappear. Rather than being 49th or 50th in health rankings, we would be ranked much higher. We would not be at the bottom. The emphasis they place on prevention and primary care is certainly a way we could impact healthcare throughout the State of Mississippi.”

He is concerned about being able to institute the concept with the current decline in the national economy. This concept can cost more initially.

“Some of these things we will have to invest in now hoping for savings down the road,” Dees said. “But we are at a point where the current system we have in this country is not working. We have 47 million people uninsured. We have a significant problem providing healthcare for people in this country. People end up in much more expensive settings where if they had a relationship with a physician in the primary care model, they wouldn’t be at the ER getting tests they didn’t need. They would be in the right place to get the care they need, but not getting care they don’t need, which we know costs the system money.”

Is healthcare going to be considered a priority with so much concern about the economy? Actually Dees think the economy may be an asset.

“Maybe the bad economy will be a driving force to reform healthcare, which we know is a significant part of the GDP,” Dees said. “Unfortunately, the U.S. spends more on healthcare than any country around the world. In countries with a large emphasis on the primary care structure, overall spending is remarkably less.”

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